| Drug Misuse Statistics Scotland 2002 |
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Drug-related deaths in Scotland, 2001 |
This chapter contains a copy of the General Register Office for Scotland's Occasional Paper No.8 published on the 7 August 2002. Papers from previous years can be found at www.gro-scotland.gov.uk
Key Points
This chapter gives information about drug-related deaths in Scotland over the period 1996 - 2001 using the new definition for baseline figures introduced last year. The new definition was agreed by a working party set up following the publication, by the Advisory Council on the Misuse of Drugs (ACMD), of a report(1) on `Reducing drug related deaths'. The Office for National Statistics has also prepared data on drug-related deaths in England and Wales using this new definition(2).
Below gives some background to the collection of information on drug-related deaths in Scotland; and summarises the main points arising from the information for 2001 and earlier years presented in Tables A6.1 - A6.6; and Annex A gives a detailed description of the definition used.
The definition of a 'drug-related death' is not straightforward. A useful discussion on the definitional problems may be found in an article in the Office for National Statistics publication Population Trends(3). More recently, a report(1) by the Advisory Council on the Misuse of Drugs (ACMD) considered current systems used in the United Kingdom to collect and analyse data on drug related deaths. In its report, the ACMD recommended that 'a short life technical working group should be brought together to reach agreement on a consistent coding framework to be used in future across England, Wales, Scotland and Northern Ireland'. GROS was represented on this group and this chapter presents information on drug-related deaths using the approach agreed. A full description of the new definition is given in Annex A.
The new definition differs in two significant ways from that used previously by GROS. First, for deaths where habitual drug abuse was not known or suspected, it limits inclusion to those where particular drugs are known to have been involved. Second, it includes deaths from intentional self-harm (suicides). Further information about the differences between the old and the new definitions may be found in GROS Occasional Paper No. 5, Drug-related deaths in Scotland in 2000(4).
Drug-related deaths are identified using details from death registrations supplemented by information from a specially designed questionnaire, completed by forensic pathologists, for all deaths involving drugs or persons known or suspected to be drug-dependent. Additionally, GROS follows up all cases of deaths of young people where the information on the death certificate is vague or suggests that there might be a background of drug abuse. A copy of the questionnaire currently used is given in Annex B. A paper(5) published in June 1995 by GROS described this enhancement to the data collection system.
There were 332 drug-related deaths in 2001, 40 (14 %) more than in 2000 and 88 more than in 1996. Within these totals, the number of deaths of known or suspected habitual drug abusers increased slightly from 220 in 2000 to 227 in 2001. Since 1996, the number of deaths in this category has risen by 30 per cent. Between 2000 and 2001 there was a large increase, from 27 to 52, in the number of deaths coded to the 'undetermined' category. These represent drug-related deaths of persons who were not known or suspected drug abusers and where it was not clear if the death was accidental or suicidal.
Of the 332 deaths in 2001, 96 (29%) occurred in the Greater Glasgow Health Board area. Lothian, with 54 (16%), and Grampian with 46 (14%), had the next highest totals. Whilst the number of drug-related deaths in Greater Glasgow fell slightly between 2000 and 2001 there were large increases in Lothian, Grampian and Ayrshire & Arran.
Because of the relatively small numbers involved, particularly for some health board areas, and the possibility that more complete information has been reported in recent years, care should be taken when assessing the trends shown in Tables A6.1 and A6.2.
Most deaths (87%) were to persons aged under 45, with almost a quarter (24%) aged under 25. Of the 43 cases aged 45 and over, only 15 were known, or suspected, to be drug-dependent. Men accounted for four out of five (80 %) of the 332 drug-related deaths in 2001. Almost three-quarters (73%) of the male deaths were of known or suspected drug abusers compared to under a half (49%) of the female deaths.
Tables A6.5 and A6.6 give information on the involvement of selected drugs, either alone or, more commonly, in combination with other drugs. Since the tables record individual mentions of particular drugs they involve double counting of some deaths. It is believed that for the overwhelming majority of cases where morphine has been identified in post-mortem toxicological tests its presence is a result of heroin use. The tables therefore show a combined figure for 'heroin/morphine'.
In 2001, the drugs listed were known to be involved in 296 (89%) of the 332 deaths. Heroin/morphine was involved in 216 (65%) of the deaths; diazepam was involved in 156 (47%) of the deaths; and methadone was involved in 69 (21%) of the deaths. A wide range of drug combinations was recorded. Of particular note was the fact that diazepam was also mentioned in over half (110) of the 216 deaths involving heroin/morphine. The presence of alcohol was mentioned for 140 of the 332 drug-related deaths in 2001. The blood-alcohol level was not given for all cases but, where mentioned, it was often at a relatively low level.
Table A6.5 shows that there have been significant increases in the involvement of heroin/morphine, and to a lesser extent diazepam, between 1996 and 2001. There have also been marked increases in the smaller numbers involving cocaine and ecstasy. Between 1996 and 2000 there was a downward trend in the number of deaths involving methadone, but there was an increase in the latest year. The table also shows a marked reduction in the number of deaths involving temazepam.
Table A6.6 shows some geographical differences in the reported involvement of certain drugs. For example, heroin/morphine was mentioned in a much larger proportion (78 out of 96) of the deaths in Greater Glasgow than in Lothian (29 out of 54). A similar picture emerges for diazepam which was involved in 52 out of 96 of the deaths in Greater Glasgow compared to only 18 out of 54 in Lothian. However the pattern is reversed for methadone - only 12 out of 96 deaths in Greater Glasgow compared to 14 out of 54 in Lothian. It should also be noted that methadone was involved in 12 of the 19 deaths in Tayside.